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Date Posted: 19:41:09 07/24/02 Wed
Author: moonotter
Subject: Most Young HIV-Positive Gay/Bisexual Men in US Unaware of Serostatus

Most Young HIV-Positive Gay/Bisexual Men in US Unaware of Serostatus


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 08 - The majority of young gay and bisexual men infected with HIV who live in large US urban areas are unaware of their serostatus, according to the results of a community-based study present here Monday at the XIV International AIDS Conference.

Furthermore, 59% of the HIV-positive men surveyed reported that they considered themselves to be at low risk for infection, lead researcher Dr. Duncan MacKellar, of the Centers for Disease Control and Prevention, told conference participants.

Dr. MacKellar and his colleagues conducted an anonymous survey of 5719 gay or bisexual men, between the ages of 15 and 29 years old, who resided in Los Angeles, Seattle, Dallas, Baltimore, Newark or Miami. The data were collected in neighborhoods, dance clubs and other settings popular among gay men.

Of the 573 men who tested positive for HIV infection, 440 (77%) were unaware of their infection and may have inadvertently transmitted the virus to their partners. The rate was especially high among HIV-infected African American men, 91% of whom reported they did not know their serostatus. Seventy and 60% of Hispanic and white men, respectively, did not know they were infected.

"Over half had either not been tested in the past year or had never been tested for HIV," Dr. MacKellar said. In the previous 6 months, half of the 440 reported having unprotected anal intercourse with one or more men, and nearly half of these men reported that they did not use condoms because they believed that they or their partners were at low risk of infection.

"We definitely need to do more research into barriers to HIV testing," Dr. MacKellar told Reuters Health. Although this study did not explore those factors, others have suggested that the stigma of being tested for HIV remains a barrier to testing, he said. In the current study, the subjects listed two primary reasons for not getting tested--they perceived themselves to be at low risk of infection or they were "scared to learn the results."

"We've got to do a better job of making sure that young men who have sex with men really understand the risks they are engaging in and the risks for acquiring HIV infection," Dr. MacKellar concluded. "We also need to do a better job of getting the word out of the benefits of early diagnosis and care."

In a second report, Dr. Ron Stall, also of the CDC, told conference participants that four psychosocial health problems--multiple drug use, partner violence, history of childhood sexual abuse, and depression--appear to interact to increase high-risk sexual behavior among gay and bisexual men in the US.

"The Urban Men's Health Study is a population-based sample of men who have sex with men," Dr. Stall told conference participants. Rather than sampling men in bars and other venues as is done in many other studies, the researchers "sampled neighborhoods in four American cities than are known to have a relatively high proportion of men who have sex with men. The four cities were San Francisco, Los Angeles, Chicago and New York."

In the course of surveying the 2281 men on a broad range of health problems that included sexual and mental health issues, "we were struck by the extent to which each of the health problems turned out to predict the other," Dr. Stall explained. There appeared to be "an interlocking web" of health problems among the gay men in these cities constituting "simultaneous epidemics that are feeding each other."

The correlation between HIV risk behaviors and multiple drug use, partner violence, history of childhood sexual abuse and depression were particularly "striking." Of those who reported all four problems, 33.3% also reported high-risk sexual behaviors. In contrast, among those who reported none of these problems, only 7.1% reported high-risk sexual behaviors. Similarly, HIV infection was reported by 25% with all four problems, compared with only 13% of those with none of these four other problems.

Overall, the HIV epidemic in this population is "intertwined with and fueled by other psychosexual health problems," Dr. Stall concluded. "One of the reasons why these men may not be able to respond to [HIV] intervention campaigns is that they are dealing with these other problems." He therefore suggests that HIV prevention efforts may be enhanced by focusing on these other issues, "particularly substance abuse and depression."



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